INTRODUCTION: Autosomal dominant polycystic kidney disease (ADPKD) is a common genetic disorder that frequently leads to end-stage renal disease. In this study, we examine the indications, procedures, and outcomes of native nephrectomy (NN) in ADPKD patients at our transplant center. Drawing on 25 years of clinical practice, we aim to provide insights into the surgical management of ADPKD, focusing on the specific factors influencing NN. MATERIALS AND METHODS: A retrospective study was conducted involving ADPKD patients who underwent KT and NN between 1999 and 2023. Collected data encompassed demographics and surgery parameters, such as duration, hospital stay length, blood loss, and complications. Patients were classified based on the urgency (acute/planned) of the NN and its type (unilateral/bilateral), followed by an analysis of the outcomes per group. RESULTS: Out of 152 patients post-KT for ADPKD, 89 (58.6%) underwent NN. The procedures were predominantly unilateral (71; 64%), with bilateral NN accounting for 40 (36%) cases. NN timing relative to KT was 31 (27.9%) pretransplant, 9 (8.1%) concomitant, 51 (45.9%) posttransplant, and 10 (9%) patients undergoing the sandwich technique. Acute NN were performed in 42 cases, while 69 were planned. Acute NNs were associated with longer surgeries, greater blood loss, and a higher incidence of perioperative complications compared to planned NNs. Specifically, unilateral acute NN had a 23.8% complication rate compared to 2.9% in planned cases; bilateral acute NN showed a 28.6% complication rate versus 4.3% in planned cases. CONCLUSION: This investigation accentuates the significance of planning and selection in NN for ADPKD, factoring in the heightened risk of complications. Acute NN are linked to worse outcomes, including higher rates of complications. The data emphasize the necessity of tailored surgical approaches based on individual patient circumstances.

• MeSH
• časové faktory MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• nefrektomie * metody   MeSH
• polycystické ledviny autozomálně dominantní * chirurgie   MeSH
• pooperační komplikace epidemiologie   etiologie   MeSH
• retrospektivní studie MeSH
• transplantace ledvin * MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

U pacientů s transplantovanou ledvinou představuje perkutánní extrakce konkrementu (PEK) zákrok vyžadující zohlednění specifických anatomických a fyziologických podmínek štěpu. Tato kazuistika popisuje případ 69letého muže, u něhož byla PEK indikována pro opakované záněty transplantované ledviny a progresi velikosti konkrementů. Zákrok byl úspěšně proveden bez reziduální litiázy, avšak pooperačně se objevily komplikace, včetně krvácení a infekce, které si vyžádaly akutní chirurgickou revizi a intenzivní péči. Díky rychlému zásahu a následné léčbě se podařilo zachovat funkci transplantované ledviny. Případ zdůrazňuje význam precizní diagnostiky, vhodného terapeutického postupu a pečlivého pooperačního sledování pro minimalizaci komplikací a dlouhodobé zachování štěpu.

In patients with a transplanted kidney, percutaneous nephrolithotomy (PCNL) is a procedure that requires consideration of the graft ́s specific anatomical and physiological conditions. This case report describes a 69-year-old man who underwent PCNL due to recurrent graft infections and the progression of stone size. The procedure was successfully completed without residual lithiasis; however, postoperative complications, including bleeding and infection, required emergency surgical revision and intensive care. Prompt intervention and subsequent treatment preserved the function of the transplanted kidney. This case highlights the importance of precise diagnosis, appropriate therapeutic strategies, and thorough postoperative monitoring to minimize complications and ensure the long-term preservation of the graft.

• MeSH
• lidé MeSH
• pooperační komplikace MeSH
• senioři MeSH
• transplantace ledvin * MeSH
• urolitiáza * terapie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• kazuistiky MeSH

Roboticky asistovaná radikální prostatektomie je standardní metodou léčby lokalizovaného karcinomu prostaty. Přesto zůstávají pozdní funkční komplikace jako stresová inkontinence moči, erektilní dysfunkce a striktury hrdla močového měchýře zásadními faktory ovlivňujícími kvalitu života pacientů. Tento článek se zabývá možnostmi prevence těchto komplikací prostřednictvím optimalizace chirurgických technik a individualizované rehabilitační péče. Důraz je kladen na šetrné operační postupy, zachování klíčových anatomických struktur a důslednou pooperační péči a fyzioterapii. Výsledky studií ukazují, že kombinace těchto přístupů může významně přispět ke zlepšení pooperačních výsledků a urychlit návrat pacientů k běžnému životu. Komplexní přístup zahrnující precizní chirurgické metody, systematickou rehabilitaci a edukaci pacientů je nezbytný pro minimalizaci nežádoucích účinků a maximalizaci kvality života po operaci.

Robot-assisted radical prostatectomy is the standard treatment for localized prostate cancer. However, late functional complications such as stress urinary incontinence, erectile dysfunction, and bladder neck strictures continue to be critical factors affecting patients' quality of life. This article explores strategies to prevent these complications through optimized surgical techniques and individualized rehabilitation care. Emphasis is placed on minimally invasive surgical approaches, preservation of key anatomical structures, and comprehensive postoperative management, including physiotherapy, pharmacological support, and technical aids. Studies indicate that combining these approaches can significantly improve postoperative outcomes and accelerate patients' return to daily life. A comprehensive approach integrating precise surgical methods, systematic rehabilitation, and patient education is essential to minimizing adverse effects and maximizing quality of life after surgery.

• MeSH
• erektilní dysfunkce etiologie   prevence a kontrola   MeSH
• lidé MeSH
• pooperační komplikace prevence a kontrola   MeSH
• prostatektomie * metody   škodlivé účinky   MeSH
• roboticky asistované výkony MeSH
• stresová inkontinence moči etiologie   prevence a kontrola   MeSH
• striktura uretry etiologie   prevence a kontrola   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• přehledy MeSH

PURPOSE: It was aimed to determine whether there is a statistically significant difference between various types of displaced supracondylar fractures of the humerus in children with movement impairment according to Flynn's classification. METHODS: Clinical results of 263 patients who were operated on with closed reduction and percutaneous pinning for displaced supracondylar fracture of the humerus were evaluated. Flynn's classification was used to compare movement impairment. RESULTS: One year after the procedure, only one patient in the category of extension fractures of type II displacement, and only in elbow flexion, had an unsatisfactory treatment outcome according to Flynn. All other patients achieved a satisfactory treatment outcome, with the vast majority, 252 patients (96%), in the excellent category. Four patients were in the good category, one patient in the fair category, and the aforementioned one patient in the poor category. CONCLUSION: In 1 year after the surgery, the limitation of elbow mobility is usually insignificant regardless of the grade of displacement or type of supracondylar fracture of the humerus. LEVEL OF EVIDENCE: Level III-retrospective comparative study.

• Publikační typ
• časopisecké články MeSH

Urologické komplikace jsou častým a významným problémem u dialyzovaných pacientů. Infekce močových cest (IMC), urolitiáza, benigní hyperplazie prostaty (BHP) a erektilní dysfunkce (ED) negativně ovlivňují kvalitu života a mohou komplikovat nefrologickou péči, včetně transplantace ledviny. Tento přehledový článek shrnuje patofyziologii, diagnostické přístupy a terapeutické možnosti urologických komplikací u dialyzovaných pacientů na základě aktuálních studií a klinických doporučení. Infekce močových cest jsou u dialyzovaných pacientů běžné a mohou mít atypický průběh. Urolitiáza se v této populaci vyskytuje méně často, ale její management je specifický vzhledem k metabolickým změnám spojeným s chronickým onemocněním ledvin. BHP je u dialyzovaných mužů často poddiagnostikována kvůli snížené diuréze, přičemž po transplantaci může vést k akutní močové retenci. Erektilní dysfunkce má vysokou prevalenci a multifaktoriální etiologii, včetně hormonálních, cévních a neurologických změn. Urologické komplikace u dialyzovaných pacientů vyžadují včasnou diagnostiku a multidisciplinární přístup. Optimalizace léčby může snížit morbiditu, zlepšit kvalitu života a předejít komplikacím po transplantaci ledviny. Další výzkum je nutný pro optimalizaci nefrologicko-urologické péče v této specifické populaci.

Urological complications are a common and significant issue in dialysis patients. Urinary tract infections (UTIs), urolithiasis, benign prostatic hyperplasia (BPH), and erectile dysfunction (ED) negatively impact the quality of life and may complicate nephrological care, including kidney transplantation. This review article summarizes the pathophysiology, diagnostic approaches, and therapeutic options for urological complications in dialysis patients based on current studies and clinical recommendations. Urinary tract infections are frequent in dialysis patients and may present with atypical manifestations. Urolithiasis occurs less commonly in this population, but its management is specific due to metabolic changes associated with chronic kidney disease. BPH is often underdiagnosed in dialysis patients due to reduced diuresis, whereas after transplantation, it may lead to acute urinary retention. Erectile dysfunction has a high prevalence and a multifactorial etiology, including hormonal, vascular, and neurological changes. Urological complications in dialysis patients require early diagnosis and a multidisciplinary approach. Optimizing treatment can reduce morbidity, improve quality of life, and prevent complications after kidney transplantation. Further research is needed to enhance nephro-urological care in this specific population.

• MeSH
• chronické selhání ledvin komplikace   MeSH
• dialýza ledvin * MeSH
• erektilní dysfunkce patofyziologie   terapie   MeSH
• hyperplazie prostaty diagnóza   terapie   MeSH
• infekce močového ústrojí * diagnóza   farmakoterapie   prevence a kontrola   MeSH
• lidé MeSH
• urolitiáza diagnóza   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

BACKGROUND: Tunica albuginea plication is a common surgical treatment for Peyronie's disease that aims to correct penile curvature and improve sexual function. The goal of this study was to evaluate patient-reported outcomes, complications, and predictors of success following plication surgery in a large cohort of patients. RESULTS: This retrospective, bicenter study included 80 patients with a mean age of 48.6 years and a mean preoperative curvature of 49.2°. Postoperative satisfaction was reported by 67% of patients. Erectile dysfunction developed in 16%, and 13% experienced complications. Among those with preoperative penile pain, 42% continued to report pain postoperatively. Reoperation was required in 12% of cases. Statistically significant associations were observed between greater preoperative curvature and higher patient satisfaction, longer follow-up duration and erectile dysfunction, and longer surgery duration and persistent pain. Patients with complex curvature patterns had a higher risk of reoperation. CONCLUSIONS: Plication surgery is an effective and safe option for treating penile curvature in Peyronie's disease, particularly in patients with more severe deformities. Greater curvature severity predicted higher satisfaction, while longer surgeries and follow-up were associated with increased pain and erectile dysfunction. These findings can help guide patient counseling and surgical planning.

• Publikační typ
• časopisecké články MeSH

OBJECTIVE: To compare the impact of sleeve gastrectomy (SG) on kidney function, comorbidities, and kidney transplant (KT) rates in KT candidates with obesity with a nonsurgical cohort. METHODS: Twenty-one KT candidates with body mass index (BMI) above 35 kg/m2 underwent SG between February 26, 2021, and October 27, 2023, and were compared with 19 who did not have SG. The secondary endpoints included changes in BMI, requirements for antihyperglycemic and antihypertension medications, and preemptive KT rates. RESULTS: The mean estimated glomerular filtration rate (eGFR) increased from a pre-SG baseline of 16.7±5.4 to 23.5±8.3 and 23.5±8.6 mL/min per 1.73 m2 at 2 and 6 months after SG (P=.002 and .02, respectively), whereas it remained unchanged in the non-SG cohort: 13.8±3.4, 14.3±5.1, and 14.8±6.4 mL/min per 1.73 m2 at the pre-evaluation period, 2 months, and 6 months. A higher baseline eGFR correlated with an improvement in eGFR after SG. The BMI and insulin requirements decreased only in the SG cohort. During the follow-up period of 5.1±4.6 months, 5 (23.8%) patients in the SG cohort and no patient in the non-SG cohort underwent preemptive KT. CONCLUSION: Pretransplant SG improves kidney function and may consequently increase rates of preemptive KT in candidates not yet on dialysis. These findings need to be confirmed by prospective studies with a well-matched cohort.

• MeSH
• dospělí MeSH
• gastrektomie * metody   MeSH
• hodnoty glomerulární filtrace fyziologie   MeSH
• index tělesné hmotnosti MeSH
• ledviny patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• obezita * chirurgie   komplikace   MeSH
• transplantace ledvin * statistika a číselné údaje   metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Parastomální hernie (PH) představuje významnou komplikaci u pacientů po operaci s použitím ileálního konduitu, přičemž její výskyt se podle literatury pohybuje v širokém rozmezí 10–65 %. Vzhledem k vysokému riziku a morbiditě spojené s PH se stále více zkoumá možnost prevence této komplikace pomocí profylaktické implantace síťky. Tento přístup, již úspěšně aplikovaný u jiných typů stomických operací, jako jsou kolostomie a ileostomie, slibuje podobné výhody i pro pacienty s ileálním konduitem. Tento systematický přehledový článek hodnotí šest dosavadních studií, které se zaměřují na účinnost a bezpečnost profylaktické síťky při prevenci PH. Výsledky naznačují, že implantace síťky může snížit incidenci PH při minimálním riziku komplikací, což představuje důležitý krok směrem ke zlepšení péče a kvality života pacientů podstupujících tento typ operace.

Parastomal hernia (PH) is a significant complication in patients undergoing surgery with an ileal conduit, with reported incidence rates ranging widely from 10% to 65% in the literature. Due to the high risk and morbidity associated with PH, the potential for prevention through prophylactic mesh implantation is increasingly being explored. This approach, already successfully applied in other types of stoma surgeries, such as colostomies and ileostomies, holds similar promise for patients with an ileal conduit. This systematic review article evaluates six existing studies focusing on the efficacy and safety of prophylactic mesh for PH prevention. The findings suggest that mesh implantation can reduce the incidence of PH with minimal risk of complications, representing an important step toward improved care and quality of life for patients undergoing this type of surgery.

• MeSH
• chirurgické stomie MeSH
• cystektomie metody   MeSH
• diverze moči metody   MeSH
• enterostomie metody   MeSH
• hernie * terapie   MeSH
• lidé MeSH
• pooperační komplikace diagnóza   prevence a kontrola   terapie   MeSH
• profylaktické chirurgické výkony metody   MeSH
• systematický přehled jako téma MeSH
• Check Tag
• lidé MeSH

OBJECTIVE: Benefits of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in kidney transplant (KT) recipients have not been adequately studied. METHODS: We retrospectively examined the effects of GLP-1 RA on mortality, kidney outcomes and metabolic parameters in KT recipients with type 2 diabetes mellitus (T2DM) treated versus not treated with GLP-1 RA. A reference group of KT recipients not treated with GLP-1 RA was used for comparison. Data were analyzed using analysis of variance, χ2 tests, and generalized estimating equation models. GLP-1 RA was used as a time-dependent model in Cox regression modeling. For survival analysis, the final model fitting was stratified by race-ethnicity. RESULTS: Seventy-seven KT recipients with T2DM were treated with GLP-1 RA for at least 12 months. Reference group included 2094 patients not on GLP-1 RA. The mean (SD) age at transplant was 57.9 (9.5) and 60.8 (9.5) years for the treatment and reference groups, respectively. Median follow-up time from the index date for mortality was 1.5 (IQR 0.99, 2.4) in the treatment and 5.8 (IQR 3.4, 9.1) years in the reference group. GLP-1 RA use was associated with improved survival (P = .049), decreased urine albumin to creatinine ratio (net reduction of 10.62 mg/g per year, P = .003), slower estimated glomerular filtration rate decline (1.04 vs 1.56 mL/min/1.73 m2 per year, P = .04), and lower troponin levels. CONCLUSIONS: GLP-1 RA in KT recipients with T2DM was associated with reduced mortality, and improved kidney function compared to the reference group. Larger, prospective studies are needed to fully evaluate the risks and benefits of GLP-1 RA therapy in KT recipients.

• MeSH
• agonisté receptoru pro glukagonu podobný peptid 1 * MeSH
• diabetes mellitus 2. typu * farmakoterapie   mortalita   komplikace   MeSH
• hypoglykemika * terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• retrospektivní studie MeSH
• senioři MeSH
• transplantace ledvin * mortalita   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BackgroundSulodexide is a glycosaminoglycan-based drug prescribed to patients with angiopathy. We performed a pilot study to investigate whether sulodexide positively modulates the endothelial glycocalyx (EG) layer and the microcirculation in a porcine model of EG enzymatic damage. The EG is a sugar-based endothelial lining that is involved in the physiology of the capillary wall and the pathogenesis of many diseases.MethodsEG damage was induced in eight piglets by hyaluronidase III and heparanase I given intravenously. Four animals received sulodexide 600 IU intravenously before the enzymes and four animals after the enzymes were administered. Four animals constituted a control group. Sublingual microcirculation by side-stream dark field imaging and plasmatic concentration of syndecan-1 by ELISA were measured at baseline, 20 min after intervention, and at the 40th, and 60th minute onwards. The statistics were performed with a one-way ANOVA test with Turkey's correction for multiple comparisons testing. Timepoint comparison was performed by Student t-test or Mann-Whitney test.ResultsAt baseline, there were no statistically significant differences between the animal groups. After the intervention, the levels of syndecan-1 were significantly lower in the control group. While there were no differences between the two intervention groups. The sublingual microcirculation analysis showed that the DeBacker score was significantly higher in the control group. At 60 min, there was also a statistically significant difference in DeBacker score between the groups (8.1 ± 1.6 mm-1 in the group with enzymes given first and 11 ± 0.92 mm-1 in the group with sulodexide given first, p = 0.03). The analysis of the proportion of perused vessels did not show any statistically significant differences.ConclusionThe results of the study demonstrated a working model of EG damage but no specific action of sulodexide on EG modulation. In the sublingual microcirculation analysis, the sulodexide reduced the fall in absolute tissue perfusion in 60 min.

• MeSH
• cévní endotel * účinky léků   MeSH
• glykokalyx * účinky léků   metabolismus   MeSH
• glykosaminoglykany * farmakologie   MeSH
• hyaluronoglukosaminidasa MeSH
• mikrocirkulace účinky léků   MeSH
• modely nemocí na zvířatech MeSH
• pilotní projekty MeSH
• prasata MeSH
• syndekan-1 krev   MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH